Pediatric myocardial protection: an overview

Seminars in Thoracic and Cardiovascular Surgery
B S AllenM N Ilbawi

Abstract

This article describes the experimental infrastructure and subsequent successful clinical application of a comprehensive bypass and cardioplegic strategy that limits intraoperative injury and improves postoperative outcomes in pediatric patients. The infant heart is at high risk of damage from poor protection because of preoperative hypertrophy, cyanosis, and ischemia. The background factors of vulnerability to damage caused by cyanosis and ischemia are discussed, together with studies of the infrastructure of strategies to use normoxia versus hyperoxia as bypass starts, white blood cell filtration, warm induction and reperfusion with substrate enhancements, multidose blood cardioplegia, and an integrated approach to allow ischemia only when vision is needed in pediatric surgeries. Data on cardioplegic management, including reducing calcium, increasing magnesium, and reducing perfusion pressure are shown, as used during this technique. These principles were applied to a consecutive series of 567 patients at the Heart Institute for Children and University of Illinois hospital over a 2-year period. Included also were 72 patients with hypoplastic left heart over a 4-year period with this myocardial management strategy. Application...Continue Reading

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Citations

Apr 10, 2013·Histochemistry and Cell Biology·Susi ZaraAndrea Porzionato
Apr 22, 2014·Journal of Cardiothoracic and Vascular Anesthesia·Asli Dönmez, Okan Yurdakök
Mar 10, 2007·The Canadian Journal of Cardiology·Carin WittnichKarim S Bandali
Apr 9, 2005·Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual·Christo I TchervenkovRoss M Ungerleider
Jul 31, 2004·Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual·Bradley S Allen
Jan 12, 2013·Artificial Organs·Rıza Turkoz
Jun 30, 2004·The Journal of Thoracic and Cardiovascular Surgery·Bradley S Allen
Apr 10, 2004·Journal of Cardiothoracic and Vascular Anesthesia·Nobuaki Shime
Mar 27, 2003·The Journal of Thoracic and Cardiovascular Surgery·Bradley S AllenLouis J Ignarro
Dec 23, 2003·The Journal of Thoracic and Cardiovascular Surgery·Karim S BandaliCarin Wittnich
Dec 23, 2003·The Journal of Thoracic and Cardiovascular Surgery·Bradley S AllenZhongtou Tan
Jul 27, 2010·The Journal of Thoracic and Cardiovascular Surgery·Stacy B O'BlenesSusan Howlett
Dec 11, 2003·The Journal of Thoracic and Cardiovascular Surgery·Bradley S Allen
Apr 22, 2016·Pediatrics International : Official Journal of the Japan Pediatric Society·Dai AsadaKenji Hamaoka
Mar 9, 2012·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Bradley S Allen, Gerald D Buckberg
Jan 1, 2005·Multimedia Manual of Cardiothoracic Surgery : MMCTS·Christian Schlensak
Jul 28, 2004·American Journal of Physiology. Heart and Circulatory Physiology·K S BandaliC Wittnich
Jul 11, 2006·Current Opinion in Anaesthesiology·Christian F Stocker, Lara S Shekerdemian
Oct 18, 2005·American Journal of Physiology. Heart and Circulatory Physiology·Steven E AndersonPeter M Cala
Aug 1, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Bradley S Allen
Mar 1, 2006·Pharmacotherapy·Michael P DorschCam Patterson
Jul 31, 2020·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Bradley Allen
Jan 1, 2016·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Bradley Allen, Gerald Buckberg
Feb 16, 2010·American Journal of Physiology. Heart and Circulatory Physiology·Masayoshi ItoIvan M Rebeyka
Oct 20, 2018·World Journal for Pediatric & Congenital Heart Surgery·Fadoua LachhabSaid Moughil
May 9, 2003·The Annals of Thoracic Surgery·Torsten DoenstFriedhelm Beyersdorf

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